Sanne de Bruin

14 Chapter 1 biochemical and immunological changes. Several methods and techniques have been assessed in order to minimize this storage lesion including different storage tempera- tures, different additive solutions and different type of storage bags. Table 1. Overview of different additive solutions used for RBC storage and their content. *PAGGGM is an experimental additive solution, currently under research Ingredients (mmol/L) Additive solution SAGM AS-1 AS-3 AS-5 AS-7 PAGGGM* PAGGSM NaCl 150 154 70 150 - - 72 NaHCO3 - - - - 26 - - NaH2PO4 - - 23 - - 8 8 Na2HPO4 - - - - 12 8 16 Na-gluconate - - - - - 40 - Citric acid - - 2 - - - - Na-citrate - - 23 - - - - Adenine 1.25 2 3 2.2 2 1.4 1.4 Guanosine - - - - - 1.4 1.4 Glucose(dextrose) 50 111 55 45 80 47 47 Mannitol 29 41 - 45.5 55 55 55 pH 6.2 5.5 5.8 5.5 8.5 8.2 6.0 The storage lesion of RBCs To preserve the quality of RBCs during storage, an additive solution is used. In Europe, the current standard additive solution is SAGM (saline-adenine-glucose-mannitol). In the Netherlands, RBCs can be stored for a maximumof 35 days at 4˚C. The storage lesion in RBCs includes several morphological, immunological and metabolic changes. Additive solutions have been developed to preserve the metabolic homeostasis of RBCs as well as possible. Worldwide several different additive solutions are used for RBCs (table 1). During storage in SAGM the intracellular pH declines to <6.5 40 . The intracellular pH has a large effect on the glucose metabolism during storage. Since RBCs do not contain mitochondria, they are completely dependent on the glycolysis for ATP production. In RBCs glucose is mainly catabolised in the glycolysis, Luebering Rapoport shunt and the pentose phosphate pathway (Figure 2). These pathways play a vital role in fulfilling the energy requirement of RBCs, the oxygen delivery capacity of RBCs and the detoxification of reactive oxygen species, respectively.